Healthcare Provider Details

I. General information

NPI: 1780852228
Provider Name (Legal Business Name): ALLIANCE PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 LAMME RD
MORAINE OH
45439-3215
US

IV. Provider business mailing address

1 PRESTIGE PLACE SUITE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-534-4632
  • Fax: 937-534-4609
Mailing address:
  • Phone: 937-762-1300
  • Fax: 937-522-8493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY Y KO
Title or Position: CFO
Credential:
Phone: 937-558-3223